Thomas Jefferson University Jefferson Digital Commons Department of Occupational Therapy, Presentations Department of Occupational Therapy 8-24-2017 Interprofessional Grand Rounds: Student Hotspotting Team 2016-2017 Caroline Komanecky SKMC, Thomas Jefferson University, Caroline.Komanecky@jefferson.edu Peter Sacci SKMC, Thomas Jefferson University, peter.sacci@jefferson.edu Danielle McFadden Nursing, Thomas Jefferson University, danielle.mcfadden@jefferson.edu Nuriya Neumann Occupational Therapy, Thomas Jefferson University, nuriya.neumann@jefferson.edu Michaela Scotten Occupational Therapy, Thomas Jefferson University, michaela.scotten@jefferson.edu See next page for additional authors Let us know how access to this document benefits you Follow this and additional works at: http://jdc.jefferson.edu/otpresentations Part of the Nursing Commons, Occupational Therapy Commons, and the Pharmacy and Pharmaceutical Sciences Commons Recommended Citation Komanecky, Caroline; Sacci, Peter; McFadden, Danielle; Neumann, Nuriya; Scotten, Michaela; and Murphy, Melissa, "Interprofessional Grand Rounds: Student Hotspotting Team 2016-2017" (2017). Department of Occupational Therapy, Presentations. Paper 41. http://jdc.jefferson.edu/otpresentations/41 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Department of Occupational Therapy, Presentations by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: JeffersonDigitalCommons@jefferson.edu.
Authors Caroline Komanecky, Peter Sacci, Danielle McFadden, Nuriya Neumann, Michaela Scotten, and Melissa Murphy This presentation is available at Jefferson Digital Commons: http://jdc.jefferson.edu/otpresentations/41
Interprofessional Grand Rounds: Student Hotspotting Team 2016-2017 Students: Caroline Komanecky, Peter Sacci - Medicine Danielle McFadden - Nursing Nuriya Neumann, Michaela Scotten - Occupational Therapy Melissa Murphy - Pharmacy Student Advisors: Charles Baron, Gerald Gibbons - Medicine & Public Health Faculty Advisors: Krys Foster, MD, MPH, Tracey Vause Earland, PhD, OTR/L, Julia Ward PhD, RN & Eileen Winter, ACSW
Sponsors Camden Coalition Primary Care Progress Association of American Medical Colleges Jefferson Center for Interprofessional Education
What is Hotspotting?
Our Team
Kick-Off Event Event Kick-Off Event Wrap-Up Event
Project Timeline Planning phase Developed goals, team norms, and rotating meeting roles Patient recruitment phase Biweekly meetings Utilized all available connections, resources Working phase Weekly meetings 3 teams of 2 students working with 1 patient/team 2 teams of 3 students working with 2 patients/team Wrap-up phase Coordinated transition of care
Team Process Weekly meetings with team and mentors Case updates and discussion Camden Coalition programming Curriculum videos Skills Labs Case Conferences
Super-Utilizer Case Story* Basic Information 40 y.o. AA female No children, not married - in a relationship Finished high school - no history of employment Experiencing homelessness Has mother and sister in Philadelphia - poor relationship Struggles to manage colostomy Diagnosis of schizophrenia, chronic conditions *Our team collaborated with 4 total patients; we chose to highlight this patient s case, which required the most intensive interventions
Why is she here so much? Month October November December Number of ED visits 35 11 19 Top Chief Complaints Abdominal pain (10) Bleeding from stoma (3) Need for colostomy supplies (3) Abdominal pain (2) Ankle pain (2) Seizure (5) Pain (4) Top Diagnoses Encounter for general attention (9) Homelessness (5) Abdominal pain (3) Homelessness (2) Colostomy malfunction (2) Encounter for general attention (2) Epilepsy (6) Homelessness (5)
Client-centered Goals & Intervention Medical management: Colostomy maintenance and reversal Medication management (explanations of medications & dosages; cell phone reminders; calendar for medication and follow-up appointments, pill box) Making and attending specialist appointments & including family members Training for colostomy care with Colorectal Surgery staff Housing opportunities: Lack of accessibility due to family circumstances Collaboration with Project Home Conversations with local case workers familiar with patient Meeting with family members
Client-centered Goals & Intervention, cont. Library card: Desire to take classes and have a place to spend the day In order to obtain, client needed 2 documents with proof of residency Family denied having mail with client's name as proof of residence Client does not receive any current mail Psychiatric Services: Client expressed interest in counselling Identified coverage of insurance and available psychiatric services
Recent Encounters: Colostomy Reversal Radiology Appointment #1 Client went in for CT with contrast to identify infection preventing colostomy reversal - unsuccessful due to non-compliance with procedure Care plan to be continued once communication is reestablished Radiology Appointment #2 Sedative provided by surgeon in order to make procedure more tolerable Efforts (music for relaxation, conversations with boyfriend & resident) were not successful, patient still refused barium enema
Hospital Utilization & Costs July - December 2016* *for TJUH alone (patient utilizes 6+ health systems) PRE-INTERVENTION (July-Sept 16): - $53,200** POST-INTERVENTION (Oct-Dec # of visits 16): - $64,325*** **costs estimated; ***exact ER costs; estimated admission costs 1st meeting with patient on 10/3/16
Possible Factors Impacting Utilization Rates Jefferson ED: Initial meeting spot for patient and students Location switched to fast food restaurant, neighborhood shelter, and medical office Varying utilization of hospital systems in Philadelphia Based on contact with family & partner Physical & mental health Need for housing Weather conditions Availability of shelter
Final Steps Patient s goals were addressed Patient received client-centered care Patient feels safe in ER
Handoff to Super Utilizer Nurse Practitioner Team Underlying factors need to be addressed moving forward Housing Cognition Safe relationships Self-perception of ability to care for ostomy Transitional team meeting Connection to Primary Care Physician Nursing Home Placement
Key Lessons Learned Importance of family support Role of stable housing on health and healthcare Challenges of medication management Impact of purposeful daily activities and community contribution on physical/mental health Mismatch of hospital intervention and patient needs/wants Access to further education and appropriate learning opportunities Mental health diagnoses mixed with cognitive impairments Role of reflection on the process of patient care and interprofessional collaboration Importance of therapeutic relationship Resources in the community Setting boundaries Transition of care
Reflecting On The Experience How will this impact our practice? Redefining success as making a positive impact on a patient s life and building a relationship of trust Value of harm reduction approach Power of using motivating factors Setting realistic goals for chronic disease management What have we learned about teamwork in healthcare? The importance of connecting information from each team member Increased quality and efficiency from interprofessional work We all have one focus: patient-centered care
Future of Hotspotting at Jefferson Scaling up within institution Provider and staff education regarding usefulness of program Advocacy within TJU schools to promote interprofessional education and experiences
Special thank you to... Krys Foster, MD, MPH, Tracey Vause Earland, PhD, OTR/L, Julia Ward PhD, RN & Eileen Winter, ACSW Thomas Jefferson University Hospital: physicians, nurses, pharmacists, social workers, case managers, and administrative staff Jefferson Center for Interprofessional Education (JCIPE): Lauren Collins, MD & Shoshana Sicks, EdM Jefferson Students for Interprofessional Education (JSIPE) Camden Coalition of Healthcare Providers, Primary Care Progress, and Association of American Medical Colleges
References Camden Coalition. (2015). Introduction to Hotspotting. https://vimeo.com/135480504. Gawande, Atul. (2011). The Hot spotters: Can we lower medical costs by giving the neediest patients better care? The New Yorker. http://www.newyorker.com/magazine/2011/01/24/the-hot-s potters